Glands all over the human body secrete ‘sebum oil‘, including the glands in the ear. Sebum oil helps keep our skin and hair moisturised.
The glands in the ear canal also secrete ‘cerumen oil‘ which has bacteriostatic properties and helps to protect the ear from infections.
These oils can build up into small lumps forming what we refer to as ‘ear wax‘. Ear wax generally falls out in small particles and we do not notice this happening. But for many people it builds into bigger lumps and causes a nuisance blockage.
Ear-wax in Europeans and Africans is generally light-brown to mid-brown and soft. Eastern Asians generally have lighter coloured fluffy dry ear-wax (this is caused by a genetic mutation and is known as ‘oriental ear wax‘).
Ear wax that has been in the ear a long time can solidify and become compacted and is dark brown.
Some lucky people do not generate much ear wax at all, if any, and never require ear wax removal – lucky them!
Some people do create a lot more wax than other people. Some people create hardly any ear wax and will never require ear wax removal.
Excessive ear wax production may be a genetic trait; but it could also may be down to diet or environmental factors (i.e. allergies or dusty work conditions). It is unconfirmed as to whether excessive noise also contributes towards excessive ear wax production.
Just as some people suffer from hay-fever more than others, many people suffer from aggravating ear-wax build up more than others.
We recommend anyone who is suffering from excessive ear wax production to consider having an allergy test / consultation to see if there is a possible cause that can be worked on.
In our opinion you will always learn something from having a test with Christine. It is very interesting. One of our patients recently saw Christine and discovered they were allergic to dairy products – they are currently changing their dietary habits and hoping it also impacts on their ear wax production.
Our ears have developed a natural cleansing process called ‘epithelial migration‘.
Epithelial = skin lining
Our skin cells migrate out of our ears from the centre of the ear drum in a spiral shape, twisting around the whole ear canal, until eventually the dead skin cells drop out of our ears. This natural process is designed to clear our ears of dead skin cells.
Unfortunately it doesn’t work in all of us, and the skin cells combine with the oily residue that forms into wax lumps and it congeals into a mass that fails to drop out.
This can be worse for people who have hairy ear canals, small ear canals, or dry flaky skin.
We use 3 methods to remove wax: microsuction, irrigation, and dry tool removal.
We have been trained specifically for each wax removal method.
What is ‘microsuction’?
The image shows a typical mobile microsuction unit / pump. Microsuction units can be much bigger for heavier duty purposes.
A microsuction pump acts like a mini-hoover and consists of a small suction pump unit which has a length of tubing (about 1m long) with a suction probe inserted into the end. We place a funnel shaped specula into the patients ear and carefully suction the wax out. It is imperative the clinician has good visibility and wears effective loupes with headlight.
This is particularly efficient for firm ear-wax.
What is ‘Irrigation?’
Irrigation is also commonly called ear syringing, but technically it is not.
Ear Syringing can still be done but uses an actual ear syringe as shown in the image.
For irrigation we use a ‘Guardian ProJet‘ irrigation unit as they offer good reliability and performance.
These devices exert a a pulsing spray of water into the ear to flush out softer wax. The water should be warm, as cold water can cause dizziness.
Irrigation is perfectly safe if the clinician appropriately controls the water flow pressure and angle of spray. It is advisable to undertake irrigation with clinician loupes to get a better view.
Irrigation is best for soft ear-wax.
Dry tool ear wax removal
We have a selection of additional tools for hard stubborn ear wax including mini-forceps and specially designed ear probes.
Often ear wax can bind to the shedding skin of the ear and can tangle with hairs making it very difficult to remove with irrigation and micro-suction – often we have to use all three methods in one ear with such ear wax.
These tools can be essential for removing very hard compacted ear-wax.
Sometimes it may be necessary to use all of the above methods to extract ear wax from one person.
Ear-wax contains anti-bacterial properties and is good for protecting the lining of our ear canals – as such we should not try to prevent ear wax. However, ear-wax build-up is obviously not good for anyone and we understand the desire to prevent this.
If you have persistent ear-wax problems we would suggest having an allergy test to see if you are reacting to anything – food or environmental.
If you have repeated problems we highly suggest you have your ear wax removed by a specialist to prevent any other problems occurring.
The $64,000 question!
Everyone has different needs – there is no set rule.
Some people may require their ears to be cleared every 2-3 months as their wax causes constant problems. For many it is a yearly procedure just before their holidays (as we have heard of many a ruined holiday from ear wax blockages!); for some it is 2-3 years, or once in a lifetime, and some will never need ear wax removal.
Is ear-wax removal safe?
Ear wax removal is an invasive procedure in a very delicate and sensitive part of our body. There are a number of varying risks when undertaking each different procedure – micro-suction, irrigation / syringing, and dry tool ear wax removal.
Some risks are standard, can occur often, and would be deemed acceptable – i.e dry skin may peel away and cause slight soreness or very slight bleeding.
Other risks could be more severe and would be deemed unacceptable – i.e. perforated ear-drum.
Risks must be understood, managed and controlled.
In order to do this we must first have appropriate training. At Crystal Hearing we have been trained by the Rotherham Primary Ear Care Centre.
In order to manage the risks it is important to work to practice or procedural guidelines and to have risk assessments in place.
Crystal Hearing works closely in accordance with the guidelines laid out by the British Society of Audiologists.
Crystal Hearing also has in place risk assessments for each ear wax removal method. In our risk assessments we have review control methods laid out.
For your reassurance our risk assessment for micro-suction can be viewed here.
Prior to undertaking ear-wax removal it is imperative to fill in a consent form which should clearly lay out all the contraindications or precautions of undertaking ear-wax removal. Our consent form is here for your perusal.
- Your local GP surgery – this is free, but currently there are long waiting times of possibly 2-3 months or even longer. GP’s generally only use the irrigation method which can be less effective for hard ear-wax, and this is why they ask you to use ear-drops for two weeks. Many local GP’s are now dropping their ear wax removal services altogether.
- A local professional hearing care centre / hearing aid clinic / ear wax removal clinic – we can offer quicker appointments (same day / next day), varied techniques including micro-suction, and there is no need to use ear drops.
Crystal Hearing has offered ear wax removal services since 2014.
At Crystal Hearing we have a Registered Hearing Aid Dispenser (John) and an Ear Wax Removal Specialist (Peter), specifically trained in all methods of ear wax removal by the Rotherham Ear Care Training School.
Are you registered for ear-wax removal?
This may be surprising but there is no registration body for private ear-wax removal services – it is an unregulated procedure.
Registered Hearing Aid Dispensers (RHAD’s) have to be registered with the Health and Care Professions Council (HCPC) and can undertake ear wax removal (with appropriate training for their insurance purpose), but the HCPC does not cover ‘ear wax removal’ in their scope of work for RHAD’s.
If you undertake ear wax removal services you must have treatment liability insurance – and the insurance company state you must be able to clearly demonstrate competence. For this you first must have appropriate training. We have completed training at the Rotherham Primary Ear Care Centre.
It would then also be appropriate to work in accordance with a specified practice guidance note, and to have in place up-to-date risk assessments for each ear-wax removal method. You may find many places undertaking ear-wax removal services are not implementing such essentials or indeed au-fait with them in the first place.
Crystal Hearing has adopted the guidance notes by the British Society of Audiologists, and has risk assessments in place. You can view our risk assessment for micro-suction here.
It is not a manadatory requirement to use ear drops prior to seeing us, but using them for 2-3 days can help the procedure. Overuse can make the procedure messier.
If you have had previous problems with irrigation please do not use ear drops prior to your appointment.
If you have been told you have hard impacted wax then you may wish to try Otex to help break the impacted wax apart.
NO – we do not recommend ongoing use of ear drops, unless you have been advised to use anything by your GP or a medical practitioner / chemist – i.e. for a dry skin problem (psoriasis).
If you have dry itchy ears the NHS recommendation is to use a few drops of oil every few weeks – this is obviously not much and is advised so as to not disrupt the natural skin migration / protection process of the ear.
If you feel your ears are blocked but they are clear then you likely have a eustachian tube blockage. The eustachian tube is the channel that runs downwards from the middle ear (behind the ear drum) across to the cavities of the nose and throat – they are all connected.
The eustachian tube can pinch together creating a pressure vacuum behind the ear drum, which gives the feeling of having blocked ears.
This can take anything up to a few months to clear unfortunately.
It is common following colds and hay-fever symptoms – hence in April and December we see plenty of clear ears!
Many people try to relieve this with hay-fever type medication – such as piranese spray.
Others say they have success using devices like otovents.
Look up treatments for eustachian tube blockages / dysfunction. If it persists we suggest you see your GP.
Note – if flying in a plane having a blocked middle ear can be very uncomfortable during air pressure changes – so travel with care. Do not blow hard whilst holding your nose to try and resolve this. Also, do not be poking anything into your ear canals – they are definitely clear.
Will my tinnitus go after the ear-wax is removed?
Tinnitus is the perception of a sound source when there is no presence of sound stimulus – it is mostly a high pitched whine, but can often be a rushing noise like white noise. Very occasionally it can actually be music.
The important thing to note is that tinnitus is a symptom, rather than a condition – in other words, something is causing it.
Ear-wax blockages do very often cause low level of tinnitus, and once cleared the tinnitus will subside.
If you have ongoing tinnitus after you have had ear-wax removed it should seek further guidance. Especially if you are under 40, or it is present in one ear only.
If you experience tinnitus after having ear wax removed it should subside soon after.
Ear wax removal can be noisy and should be undertaken in way that minimises the impact of the noise, and certainly the duration of loud noise heard within the ear. It is very important to advise the clinician if you feel the noise is particularly loud for your own loudness tolerance levels. The clinician should then act with extra diligence to minimise the noise so as to not cause tinnitus.
Is it safe to fly after ear wax removal?
As a general answer – YES – it should be safer to fly after having ear-wax removed than flying with an ear blocked with wax. This is because your ears can equalise better when clear. (to equalise means to balance the air pressure both sides of the ear-drum).
Having a blocked ear can trap dirty swimming pool water or sea water in the ear canal and can lead to infections.
We advise that you have your ears cleared a week or two before your holiday to let them settle before going swimming as sometimes the ears can be tender if a dead layer of dry skin has peeled away with the ear-wax.
Why do i cough during ear-wax removal?
The cough reflex is a human glitch resulting from a crossover of nerves running past the ear canal.
The vagus nerve feeds much of the body as shown right, and the auricular branch of the vagus nerve runs very close to the ear canal. The facial nerve is in close proximity of the vagus nerve and a cough reflex can be triggered as a result of stimulation of the nerves passing the ear canal.
So, stimulating the ear canal can trigger a cough – and in reverse, a chronic ear pain can actually be a result of a problem in the throat! – note chronic means long term – so if suffering chronic ear pain with no obvious cause int the ear, your throat should be examined – note ENT stands for Ears Nose and Throat for a reason!
This reflex glitch is called the Arnold nerve reflex – after Friedrich Arnold, a 19th-century German scholar who discovered it.
The required level of stimulation to trigger a cough can vary greatly – some people cough at the slightest touch. This can make ear-war removal tricky, and micro-suction ear wax removal may be too risky in such circumstances.
Are cotton-buds (Q-tips) safe to use in my ear?
Cotton buds should not really be used within the ear canal. They are perfectly safe to use to clean the outer ear (the ‘pinna’ – the ear that we can clearly see).
The inherent danger of using a cotton bud in the ear canal is pushing it too deep and perforating your ear-drum. This could cause permanent damage and is not worth the risk. If you simply cannot resist doing it then we urge you to hold the cotton bud as close to the white tip as possible to ensure you cannot push it deep into your ear.
Also though, as mentioned above, our ear canals secrete oils to protect our ears, and the skin cells migrate outwards in a process called epithelial migration – using cotton buds disrupts both of these processes and can actually lead to the creation of more wax as the ear over compensates to protect itself.
Do you do ear-wax removal for children?
Ear-wax removal on children can be contentious. Insurance policies states that we must be able to demonstrate competence in procedure.
There is no specific extra training offered, that we know of, to undertake ear-wax removal on children. Upon attending the courses offered by the Rotherham Primary Ear Care Centre we asked what additional training was required and they stated ‘none’.
We have spoken to our insurance company about our risk assessments and practice policy and we have decided that without further specific paediatric training we can demonstrate competence working on children from age 12, as from this age they have an adequate understanding of what the procedure can involve and how to respond if in any discomfort.
To clarify in short – we only undertake ear-ear removal on children aged 12 years or over.
We advise any parent taking their child for ear-wax removal to check if the clinician is insured to operate and can demonstrate competence in working on children – and the best way for them to show this is via an up to date and live risk assessment detailing the extra risks when working on children.
Risk assessments should cater for the following at least, along with guidelines to ensure safety: children have smaller ears and their ear canals are more horizontal; they may not understand verbal instructions; they may not tolerate noise well; their ear drums could be more fragile; they are easily distracted, they are very nervous with their ears being worked on.
Children under 16 MUST attend with a supervising adult. We encourage that adult to be a close relation to encourage the child to remain settled throughout, and one who understands the emotional displays of the child.